Moon Hyun Im, Kwon Hee Kyu, Lee Ahry, Lee Se Kwang, Pyun Sung-Bom
Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Bundang-gu, Korea.
Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.
J Ultrasound Med. 2017 May;36(5):993-998. doi: 10.7863/ultra.16.05019. Epub 2017 Mar 4.
The purpose of this study was to investigate sonographic findings according to the pathophysiologic type in patients with carpal tunnel syndrome.
We retrospectively reviewed the records of 80 patients (148 hands) with carpal tunnel syndrome. Patients were classified into 3 groups according to electrophysiologic findings: (1) conduction block and conduction delay; (2) axonal degeneration; and (3) mixed. We used sonographic evaluations to assess the cross-sectional area at the distal wrist crease and the distal forearm and the wrist-to-forearm ratio of the median nerve.
Patients with axonal degeneration had significantly larger cross-sectional areas and wrist-to-forearm ratios than those with a conduction block (P < .05). The increased wrist-to-forearm ratio correlated with a reduced amplitude of the sensory nerve action potential, which reflects the degree of axonal degeneration.
The cross-sectional area and wrist-to-forearm ratio were associated with the pathophysiologic type of carpal tunnel syndrome, with larger nerve swellings seen in patients with axonal degeneration compared with those with demyelinating lesions. In addition to helping in the localization of the nerve lesion, sonography may indicate the type of nerve lesion.
本研究旨在根据腕管综合征患者的病理生理类型，探讨超声检查结果。
我们回顾性分析了80例（148只手）腕管综合征患者的记录。根据电生理检查结果，将患者分为3组：（1）传导阻滞和传导延迟；（2）轴索性变性；（3）混合型。我们采用超声评估来测量腕部远侧横纹处和前臂远侧正中神经的横截面积以及腕部与前臂的比值。
轴索性变性患者的横截面积和腕部与前臂的比值显著大于传导阻滞患者（P < 0.05）。腕部与前臂比值的增加与感觉神经动作电位幅度降低相关，这反映了轴索性变性的程度。
横截面积和腕部与前臂的比值与腕管综合征的病理生理类型相关，与脱髓鞘病变患者相比，轴索性变性患者的神经肿胀更明显。超声检查除了有助于神经病变的定位外，还可能提示神经病变的类型。
